Provider Demographics
NPI:1053415489
Name:HOLLAND, JUDY O (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:O
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 JUSTICE AVE.
Mailing Address - Street 2:STE. A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2372
Mailing Address - Country:US
Mailing Address - Phone:225-291-6647
Mailing Address - Fax:225-291-9463
Practice Address - Street 1:11924 JUSTICE AVE.
Practice Address - Street 2:STE. A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2372
Practice Address - Country:US
Practice Address - Phone:225-291-6647
Practice Address - Fax:225-291-9463
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical